Clinical Evaluation of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia

Abstract

The practitioner should be adept at identifying those tests and procedures necessary to evaluate men with lower urinary tract symptoms (LUTS). Prior to any discussion on evaluation of LUTS, however, one must be aware of the changing terminology, which was born out of frustration with inadequate communication. The relatively new LUTS terminology was introduced by Abrams [1] to replace the old terms “prostatism,” “clinical benign prostatic hypertrophy (BPH),” and “symptomatic BPH,” because these latter terms implied that the prostate is responsible for all or most of the LUTS in men. Whereas it is well established that LUTS can be precipitated by benign prostatic enlargement (BPE) and bladder outlet obstruction (BOO), LUTS can also occur secondary to aging, neurologic diseases, and extravesical causes [2,3]. Similarly, the use of terms such as “irritative” and “obstructive” in the absence of supporting objective data was imprecise and confusing. For example, a man’s irritative symptoms of urgency or frequency may result from high bladder volumes or detrusor overactivity secondary to BOO; conversely, obstructive symptoms such as weak force of stream and abdominal straining may result from detrusor hypocontractility and not from BOO. Similarly, the term BPH implies a histologic diagnosis, which should be reserved for known prostatic tissue pathology. Also, the International Consultation on BPH (IC BPH) recommended that the terms “BPE” and “BOO” be used when appropriate to increase accuracy of communication [4].